What is the cause of heart failure?

What is heart failure?

Heart failure essentially means that that the heart muscle is unable to pump blood around the body as effectively as it used to, or as it should do. This can be due to a number of causes that leave the heart too 'stiff' or too 'weak' to work as it should; your heart is still working but you may need some extra support to help it to do its job (NHS, 2021; BHF, 2021).

There are a number of different types of heart failure that you may have (Healthline, 2021) and different types may cause slight variations in the symptoms you may experience:

• Left sided heart failure - This is the most common type of heart failure. This will mean that your heart can't pump enough oxygenated blood from your lungs to the rest of the body. There may also be a higher pressure inside the heart because it is stiffer which could lead to blood backing up in your pulmonary veins (the veins which carry blood from your lungs to your heart)
• Right sided heart failure - This is most commonly as a result of damage due to left sided heart failure but may be due to other conditions including leaking heart valves. Right sided heart failure means that the heart cannot pump enough blood from your heart to the lungs to be oxygenated and, as a result, the blood backs up in your veins.
• Systolic heart failure - Where the muscles of your left ventricle become weakened and, as a result, your heart does not pump with enough force to provide oxygenated blood to your body effectively.
• Diastolic heart failure (also called heart failure with preserved ejection fraction) - This is where the muscles of your left ventricle stiffens and can no longer fully relax which prevents the heart from filling properly in order to supply your body with oxygenated blood.

Symptoms of heart failure

The main symptoms of heart failure that are usually noted are (NHS, 2021; BHF,2021):

• Shortness of breath - This can be present during activity or at rest and may be worse at night or when you are lying down.
• Swelling - caused by fluid build-up (oedema) which often seen in the feet and legs but can spread further up the body.
• Feeling unwell, weak or tired - this is because your muscles are not receiving blood and oxygen as the required levels. 

You may also experience some other, less common symptoms, with heart failure which include: arrhythmias (abnormal heart rhythms), loss of appetite, nausea, dizziness, wheezing, a persistent cough (which is often worse at night) and weight changes (NHS, 2021).

Diagnosing heart failure

If you are experiencing any of the symptoms noted above, it is important to get in touch with your GP for a review. Testing will not only help to diagnose heart failure but should also be able to give us further indication as to the extent, or stage, of this condition; heart failure can be staged between 1 and 4, with stage 4 being the most serious (NHS, 2021).

Some tests that are commonly used to diagnose heart failure are (NHS, 2021; BHF, 2021):

• Blood tests
• Electrocardiogram (ECG)
• Echocardiogram
• Chest X-rays
• Breathing tests

If needed your GP may wish to refer you on to a specialist cardiologist to look into your condition further and carry out more diagnostic tests.

Potential causes of heart failure

There is no 'one' cause of heart failure, and it may be due to a number of different problems or conditions affecting the heart at the same time (NHS, 2021). There are a number of conditions that could contribute to the development of heart failure and the condition may develop suddenly, or it may progress more slowly over time (BHF, 2021). 

The conditions that most frequently cause the development of heart failure are (BNF, 2021):

• A heart attack - Which can cause long term damage of the heart muscle and affects how well your heart pumps
• Coronary artery disease - This is where the one or more of the arteries that supply your heard with oxygenated blood becomes narrowed due to the build-up of cholesterol, this reduces the amount of oxygen that supplied to your heart. This lack of oxygen and nutrients delivered to the heart can cause damage and may lead to symptoms of angina (Heart failure matters, 2021).
• Cardiomyopathy - A disease of the heart muscle. This may be due to an inherited cause or could be caused by a condition such as a viral infection or can occur during pregnancy.
• High blood pressure - Over time this condition can put extra strain on the heart muscle leading to damage of the heart muscle

A number of other conditions can also contribute to the development of heart failure, including (BHF, 2021; NHS, 2021):

• Endocarditis (a viral infection that effects the heart muscle)
• Congenital heart conditions (these are conditions that you are born with)
• Heart valve disease
• Arrhythmias
• Toxic effects of some drugs such as cocaine or some drugs used for chemotherapy.
• Thyroid diseases
• Anaemia
• Excessive alcohol consumption
• Pulmonary hypertension - This condition causes damage to the right side of the heart due to raised blood pressure in those blood vessels that supply your lungs (PHA, 2021)
• Amyloidosis - This is the collective name for a rare group of serious conditions which cause a build-up of abnormal proteins (amyloid) in the organs and tissues in the body, which has an effect on their abilities to carry out their roles (NHS, 2021).

Treatment options

What treatment options are advised will often depend on the underlying cause of the heart failure, and the severity of your symptoms and condition. Some of these treatments are (NHS, 2021; BHF, 2021):

• Lifestyle changes - this may include eating healthier, increasing exercise, losing weight, stopping smoking and limiting alcohol intake.
• Medications - There are many medication options that your GP or specialist may suggest to help your heart to pump more effectively and improve any symptoms you are experiencing. If you would like to talk about the possible medication options that are available, then please do give one of our Health at Hand pharmacists a call to discuss this further. You can contact us on 0800 003 004, pharmacists are available 8am-8pm Monday to Friday, 8am-4pm on Saturdays and 8am-12pm on Sundays.
• Insertion of a pacemaker of ICD - these are implanted devices to help control your heart rhythm.
• Surgery - If other treatment options have been unsuccessful then it may be suggested that you should have surgery. Surgical options could include heart valve surgery, angioplasty, coronary bypass surgery, left ventricular assist devices or, in extreme cases a heart transplant.

I hope the above information is useful but if you would like to talk things through further with one of our nurses in the Health at Hand team then please do call us on 0800 003 004; our nurses are available 24/7 to offer medical information and support.

Answered by the Health at Hand team.

Further reading

We have lots of information, tips and inspiration to support you in making lifestyle changes that can help you improve your overall health, and boost your feelgood factor too! Here are just a few to get you started:

How to develop healthy eating habits | AXA Health

Getting your salt intake right | AXA Health

Getting active - your way | AXA Health

How to lose weight well | AXA Health

Quitting smoking | AXA Health

How much is too much alcohol | AXA Health

References

British Heart Foundation, 2021. Heart failure. Available at: Heart Failure - Causes, Symptoms and Treatment - British Heart Foundation (bhf.org.uk). (Accessed 27 April 2021).

Healthline, 2021. Types of heart failure. Available at: Types of Heart Failure: Diastolic, Congestive, Biventricular and More (healthline.com). (Accessed 27 April 2021).

Heart Failure Matters, 2021. Coronary artery disease. Available at: Coronary Artery Disease and Heart Failure (heartfailurematters.org). (Accessed 27 April 2021).

NHS, 2021. Amyloidosis. Available at: Amyloidosis - NHS (www.nhs.uk). (Accessed 27 April 2021).

NHS, 2021. Heart Failure. Available at: Heart failure - NHS (www.nhs.uk). (Accessed 27 April 2021).

Pulmonary Hypertension Association, 2021. What is pulmonary hypertension? Available at: What is Pulmonary Hypertension? | PHA (phauk.org). (Accessed 27 April 2021).